A 30-year-old woman presented with a 1-year history of a pruritic eruption on the extremities, characterized by several annular plaques. The patient had been treated unsuccessfully with medium-potency topical steroids. The lesions had an erythematous papular border with an atrophic center (width, 1-4 cm) (Fig. 1). No oral, genital, or nail lesions were observed. A skin biopsy from one of the plaques was performed. Histopathologic examination of the raised border showed hyperkeratosis of the stratum corneum, focal thickening of the granular layer, basal liquefaction degeneration of the epidermis, and a band-like subepidermal infiltration with numerous Civatte bodies. In the center of the lesion, the epidermis became thinner (Fig. 2). Elastic fibers were reduced or absent in the papillary dermis. The patient was treated with high-potency topical steroids for 2 months with clinical improvement.

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Context:Rosacea significantly affects the quality of life and its pathophysiology is not well understood. It has been suggested that the presence of Demodex folliculorum in the affected skin could be related to the development of rosacea.Aims:To study the risk for association between the presence of D. folliculorum in skin biopsies and the diagnosis of rosacea.Settings and Design:Analytical, observational, retrospective, case–control study.Materials and Methods:Skin biopsies of patients diagnosed clinically as rosacea and the same number of controls were studied. The controls were selected among the facial skin biopsies that were not diagnosed as rosacea. All the slides were analyzed for the presence of D. folliculorum and the density of the infestation was assessed.Statistical Analysis Used:Absolute/relative frequencies, mean, standard deviation, odds ratio (OR), Chi square and Independent Student t-test with Epi Info v. 3.4.3®.Results:D. folliculorum was present in 80% of the skin biopsies of rosacea patients and in 30% of the controls. The risk of suffering rosacea was increased among persons infested with the mite (OR = 9.33 [95% confidence interval: 2.85-30.60]; P = 0.0001). The mean infestation density among the cases was 1.908 for every 10 high-power fields while it was 0.718 among the controls (P < 0.005). There were no statistically significant differences among the groups with regard to sex and age.Conclusions:The presence of D. folliculorum in skin biopsies is associated with the diagnosis of rosacea. The infestation density was increased among the patients with rosacea.

Here, we report a patient with serum factor positive UVA-induced solar urticaria unresponsive to omalizumab. A 64-year-old Caucasian woman presented with a 28-year history of severe solar urticaria. Wheals developed within 3 min of exposure to sunlight, including through window glass. Sunlight exposure repeatedly provoked systemic symptoms with nausea and cardiovascular reactions. The relevant induction spectrum was found to lie between 340 and 400 nm (UVA1). The minimal dose was positive at 10 J/cm 2 and a profound urticarial response was elicited in all test fields. Intradermal skin test with UVAirradiated autologous serum was positive implicating the presence of a serum factor. FBC, ANA, liver and renal profiles were normal. Serum IgE was 12,6 kU/L. Treatment with sunscreens, antihistamines, including high-dose desloratadine 20 mg/die in combination with ranitidine 300 mg/die was ineffective. Light hardening with narrow band UVB over 6 months resulted in marginal, short-lived reduction in symptoms. Two grams of Mycophenolate mofetil daily showed no effect and nine cycles of plasmapheresis resulted in only very transient improvement in the severity of symptoms.Omalizumab was commenced at a dose of 150 mg every 4 weeks. Following three treatment cycles, she reported no improvement, in contrast she felt symptoms had worsened. On

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